Health Behaviors of a Sample of Adolescents in Bandar Abbas, Iran

Teamur Aghamolaei , SedighehSadat Tavafian

2, *

1 Department of Public Health, School of Health, Hormozgan University of Medical Sciences, Bandar Abbas, IR Iran
2 Department of Health Education, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, IR Iran

*Corresponding author: Sedigheh Sadat Tavafian, Department of Health Education, Faculty of Medical Sciences, Tarbiat Modares University, P.O. Box: 14115331, Tehran, IR Iran., Tel.: +98-2182884547, Fax: +98-2182884555, E-mail: tavafian@modares.ac.ir

A BS T R A C T

Background: Health promotion for adolescents has become a research priority worldwide and life at school offers a good opportunity to
establish health promoting behavior among this age group.
Objectives: This study aimed to investigate health behaviors of a sample of adolescents in Bandar Abbas, Iran.
Materials and Methods: Totally, 410 students including 204 males and 206 females studying in grades 9 to 12 and aged between 1518 years old
were studied. The instruments used to collect data were a self administered demographic questionnaire and the scale of Adolescent Health
Promotion (AHP).
Results: The mean age of participants was 16.5 (SD = 1.34) years. The mean score of Adolescent Health Promotion (AHP) scale was 64.8 (SD =
8.9) ranging from 34.3 to 89.9. Female students scored significantly higher for health-responsibility, life-appreciation, and stress-management
than male students (P < 0.05). In contrast, male students scored higher scores on exercise behavior than female (P < 0.05). All dimensions of
AHP scale except for nutrition behavior and social support was associated with gender and nutrition behavior was associated with age (P <
0.05).
Conclusions: This study indicated that sedentary life style and physical inactivity is a common and serious problem among high school
students of Bandar Abbas.
Keywords: Health Behavior; Adolescent; Iran
Copyright 2013, Zahedan University of Medical Sciences; Published by Kowsar Corp.

1. Background
There are an estimated 1.2 billion adolescents - one in
every five people living throughout the world. On the
other hand, the vast majority of changes in physical, psychological, and social interactions happen during the
adolescence period (1). Adolescents are usually thought

of as a healthy group. Nevertheless, many adolescents

do die prematurely due to preventable events resulting
from risky behaviors like accidents, suicide, violence,
pregnancy related complications due to unprotected
sexual relationship, substance abuse and other illnesses
(2). In many countries, adolescent health problems are
considered as national health priorities (3). Various un-

Article type: Research Article; Received: 28 Oct 2012; Revised: 12 Feb 2013; Accepted: 11 Mar 2013; Epub: 26 Jun 2013; Ppub: 29 Jun 2013
Implication for health policy/practice/research/medical education:

Sedentary life style and physical inactivity is a common and serious problem among adolescents and it is necessary design appropriate strategies to improve this behavior.

Please cite this paper as:

Aghamolaei T, Tavafian SS. Health Behaviors of a Sample of Adolescents in Bandar Abbas, IR Iran. Int J High Risk Behav Addict.2013;
2(1): 34-8. DOI: 10.5812/ijhrba.8842
Copyright Zahedan University of Medical Sciences. Published by Kowsar Corp.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Aghamolaei T et al.

Health Behaviors of Adolescents

healthy behaviors such as smoking, alcohol use, and not
using condom are usually initiated during the developmental periods of adolescence or childhood. Child and
adolescent behavior may predict health behaviors and
health status in early adulthood (3, 4). Youth is an opportunity to explore needs, make decisions and form social relationships, so habits established during this part
of life would continue for the whole life (5). Nowadays,
considering health needs of adolescents and promoting
their health has become a research priority worldwide
(6). Among healthy behaviors, healthy diet and regular
physical activity are major factors influential on adolescent health promotion throughout their entire life. On
the other hand, schools offer a good opportunity for establishment of these healthy behaviors among this age
group (7, 8).
In London, a study on adolescents found that many
overweight teenagers, especially boys, did not regularly
realize that they were too fat (9). Another study showed
that adolescents who believed on high weight controllability were more likely to express that thin individuals,
compared to fat ones, would engage and benefit from
physical activity and would be satisfied regarding their
weight (10). Although international research has identified several socio-economic and cultural factors that
might be associated with overweight children (11), few
corresponding studies have been performed in eastern
countries (12). A systematic review from Iran showed that
the prevalence rate of mental disorders reported by two
studies using diagnostic instruments was equal to 16.6%
and 4.34 %, so there was a significant heterogeneity between the studies. This study concluded that the prevalence rates of mental disorders reported for high school
students of Iran had a wide range so more studies with
improved quality are needed in this field (13). A previous
study conducted in Iran showed Iranian girls faced many
barriers to an active lifestyle such as lack of enough places to exercise, access to facilities and resources, cultural
limitations, and paid lower attention to exercise over
other duties such as doing homework or home responsibilities. This study suggested that access to suitable
facilities and a supportive environment are important
strategies for promoting physical activity among female
adolescents in this country (14). To the best of our knowledge, researches regarding adolescents health behaviors
in Iran especially in Bandar Abbas a city in the south of
Iran - are very rare, so there is no doubt that this study is
the first preliminary research to investigate the status of
health behaviors among adolescents living in this area.
These data provided a first step towards the foundation of
knowledge necessary to develop interventional preventive programs to improve health promoting behaviors
of these adolescents. With this regard, this study aimed
to assess health behaviors of a sample of adolescents in
Bandar Abbas, Iran.

Int J High Risk Behav Addict. 2013;2(1)

2. Objectives
This study aimed to investigate health behaviors of a
sample of adolescents in Bandar Abbas, Iran.

3. Materials and Methods

This was a cross-sectional study conducted for high

school students of Bandar Abbas. Written consent forms
were signed by the adolescents before entering the study.
The target population of this study included adolescents who were studying in the high schools of Bandar
Abbas. This city which is located in the south of Iran, has
58 female and 67 male high schools in which students in
grade 9, 10 and 11 study. In Iran, students in grade 12 study
in pre-college centers. At the time of the study, there were
20 female and 17 male pre-college centers in Bandar Abbas that were located in different geographical points of
the city. For the first step of sampling, 20 sites (including
five female high schools, five female pre-college centers,
five male high schools and five male pre-college centers)
were selected randomly. For the second step, in each high
school 33 students (11 students from each grade) and in
each pre-college center 11 students (grade 12) were recruited if they agreed to take part in the study. In total,
440 students were recruited. Thirty students filled out
the questionnaires incompletely. Thus, a total of 410
questionnaires (204 male and 206 female students) were
analyzed. The response rate was 93.2%.
In this study a self-administered questionnaire regarding demographic characteristics, and the scale of Adolescent Health Promotion (AHP) were used as data collection
instruments. Demographic characteristics included age,
sex, and grade. The Adolescent Health Promotion (AHP)
scale assessed health-promoting behaviors. The AHP scale
was designed based on the literature and guided by the
theoretical framework of Penders health promotion
model (15). This model was derived from Bandura's Social
Cognitive Theory (16). Moreover, this scale has been used
by Iranian studies in which physical activity among adolescents were assessed (14, 17). The AHP scale consisted of
a set of 40 items that assessed six dimensions of healthy
behavior including nutrition, social support, life appreciation, health responsibility, stress management, and exercise. The frequency of reported behaviors was obtained using a self-reporting Likert scale with a five-point response
format, "never, rarely, sometimes, usually, always", with
the rating score ranging from 1 to 5. Nutrition consisted of
six items scored from 6 to 30, social support consisted of
seven items scored from 7 to 35, life appreciation consisted
of eight items scored from 8 to 40, health responsibility
consisted of eight items scored from 8 to 40, stress management consisted of seven items scored from 7 to 35, and
exercise behavior consisted of four items scored from 4 to
20. Then, raw scores for each of the six AHP dimensions
were converted to a value for the dimension from 0 to 100

35

Aghamolaei T et al.

Health Behaviors of Adolescents

according to the Wang et al. procedure (6). Higher scores

indicated higher health promoting behavior. A panel of
experts evaluated content validity and a pilot test was performed to determine whether it would be appropriate for
the target population of this study. This scale was applied
in a similar study on adolescents of Turkey (18). The reliability coefficient for each dimension that was calculated
using Cronbachs alpha coefficients for nutrition, social
support, life appreciation, health responsibility, stress
management, and exercise behavior, were calculated as
0.66, 0.70, 0.88, 0.72, 0.76 and 0.85 respectively. Following clear instructions and clarifying the aim of the study,
the questionnaires were distributed to the students. Data
Analysis: Descriptive statistics and student t-test were
used to analyze the data by the SPSS software version 16
and P < 0.05 was considered statistically significant

4. Results

The mean age of participants was 16.5 (SD = 1.34) years,

ranging from 15 to 18. The majority of participants (50.2%)
were male. Table 1, shows the demographic characteristics of the participants.
The mean score on the AHP scale was 64.8 (SD = 8.9), with
a range of 34.3 to 89.9. Table 2 compares the mean scores
of all the behaviours between the two genders. There were
significant differences between male and female students
in terms of health-responsibility, life-appreciation, exercise and stress-management dimensions (P < 0.05). Female
students scored slightly higher on health-responsibility,
life-appreciation, and stress-management and the differences were statistically significant (P < 0.05). In contrast,
male students scored higher than female students on exercise behaviour. This difference was statistically significant
(P < 0.05). However, there was no significant difference
between male and female students in terms of nutrition
behaviour and social support dimensions.

Table 1. Demographic Characteristics of the Subjects

Age ,years, (Mean SD)
15 (16.5 1.34)

99 (24.1)

16 (16.5 1.34)

94 (22.9)

17 (16.5 1.34)

112 (27.3)

18 (16.5 1.34)

105 (25.6)

Male

206 (50.2)

Female

204 (49.8)

9th

104 (25.4)

10th

120 (29.3)

Gender

Grade

11th

Nutrition behavior

Social support

Health responsibility
Life appreciation

Exercise behavior

Stress management
a Significant

77 (18.8)

Fathers education
Illiterate

12 (2.9)

Primary school

45 (11)

Secondary school

103 (25.1)

High school

161 (39.3)

University

89 (21.7)

Illiterate

38 (9.3)

Primary school

96 (23.4)

Secondary school

91 (22.2)

High school

116 (28.3)

University

69 (16.8)

Mothers education

Female, Mean SD, (N = 204)

Total, Mean SD

P Valuea

72. 12.1

70.07 14.3

71.06 13.2

0.13

62.10 12.1

63.91 14.9

63.00 13.6

0.17

61.25 15.2

65.01 14.6

63.12 15.1

80.26 14.4

83.97 13.4

82.11 14.1

49.81 23.7

33.08 25.1

41.49 25.8

66.67 12.8

70.51 14.2

68.58 13.7

5. Discussion
Although, in recent years, research on risky behaviors
among Iranian adolescents was given more attention,
assessing health-promoting behaviors of this age group

36

109 (26.6)

12th

Table 2. Comparison of Health Behavior Scores Between Male and Female Students (T-test)
Male, Mean SD, (N = 206)

No. (%)

0.01*

0.007*

0.000*
0.004*

especially through the AHP scale, was not yet performed.

This study extended our knowledge about the health
promoting behaviors of high school students living in a
southern city of Iran. According to this study, the mean
scores of most dimensions of AHP were lower than 70.

Int J High Risk Behav Addict. 2013;2(1)

Aghamolaei T et al.

Health Behaviors of Adolescents

Particularly the mean score of exercise behavior was the
lowest. This result indicated that sedentary life style and
physical inactivity is a common and serious problem
among high school students studied in this research. A
previous study conducted in Iran (19), stated that three
national surveys conducted among Iranian adults have
shown more than 80% of the Iranian population are physically inactive. Furthermore, another study (20), indicated
that Iranian youth have a sedentary life style that might
be due to spending too much time watching television
and playing computer games, as well as due to decreased
opportunities for exercise in schools and communities.
The results of the present study are consistent with the
findings of previous investigations regarding the mean
score of exercise behavior being the lowest among adolescents (6, 21). In addition to this finding about low rate
of adolescents exercise behavior, the results of this study
showed that female students had lower exercise behaviors than male students. This finding is similar to the
results of other studies that reported adolescent girls
had lower levels of physical activity compared to their
male counterparts (6, 22, 23). Our study also showed that
health responsibility and social support scores were the
second lowest among all dimensions of AHP scale. What
we can rationale about feeling low social support and
health responsibility of adolescents living in Bandar Abbas, is that the majority of these adolescents live with low
or uneducated parents. Chen and co- workers revealed
in their study (12), that living with less educated parents
was associated with lower health promoting behaviors.
This result is also consistent with what was reported by
Wang and co-workers (6), with this difference that they
examined health-promoting behaviors among university
students. Furthermore, Huurre and co-workers concluded in their study (24) that parental socio demographic
status has an influence on early adult health behavior.
As this study found, the mean scores of stress management and nutrition behavior were near 70. Since there is
no data regarding these behaviors among representative
Iranian adolescents, there is no possibility to compare
the status of stress management and nutrition behavior
of high school students of Bandar Abbas with the entire
population of adolescents in Iran. However, previous research on mental health of Iranian adolescents showed
no satisfactory position for adolescents in this regard
(24, 25). As we can see in this study, the mean score of lifeappreciation was the highest. This indicated that adolescents living in Bandar Abbas were satisfied with their life.
The rationale that could be argued for this finding is that
the adolescents studied in this study live in one of the
most disadvantaged provinces of Iran and they probability have low expectation of life. In conclusion, this study
provided basic data about health promoting behavior of
this target group and doing more research in this regard
is warranted. This study provided evidence for gender dif-

Int J High Risk Behav Addict. 2013;2(1)

ferences in all dimensions of AHP scale except for nutrition behavior and social support. Female students were
more likely to take health responsibility, to appreciate
their life and to manage their stress. However, male students were more likely to engage in exercise. A previous
study conducted among university students of China reported that male students did more exercise than female
students (6). However the present study revealed no difference between both genders with regard to social support and nutrition behavior, whereas a previous study
showed that female were more confident with regards
to the social support dimension (6). As said before, this
study was the first investigation regarding promoting
behaviors among adolescents living in Bandar Abbas.
However, there were some limitations in this study. First,
in this study, data were collected through self-reported
measures, so the results might be biased by survey takers understating regarding the degree of healthy behavior and its determinants. However, this limitation is not
unique to our study, as the majority of studies conducted
on healthy behavior have been based on self-reported
data (2, 6, 12, 14, 18). Furthermore, Cronbachs Alphas of
the instrument are borderlines and are somewhat low related to the number of items that might impact the real
data. However, this study could be the basis for future
studies without these limitations. The cross-sectional
study design was the other limitation. Therefore, designing studies that will assess the causes of risky behaviors
is strongly recommended. Furthermore, future studies
should consider these limitations to better understand
the predictors of risky behavior. This study indicated that
sedentary life style and physical inactivity is a common
and serious problem among the high school students in
Bandar Abbas.

Acknowledgements

The authors would like to thank all adolescents who

took part in this study and the high school principals
who permitted this research to be done in their schools.

Authors Contribution

All authors contributed equally in doing the research.

Financial Disclosure

This study was financially supported by Hormozgan

University of Medical sciences.

Funding/Support

The author declares no funding or support.

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